A randomized clinical trial: Efficacy of group-based acceptance and commitment therapy program for breast cancer patients with high fear of progression

Fatemeh Hassani Alimolk; Fiona Elizabeth Jean McDonald; Mohammad Asghari-Jafarabadi; Farzane Ahmadi; Saeedeh Zenoozian; Marzieh Lashkari; Pandora Patterson

doi:10.1002/pon.6339

A randomized clinical trial: Efficacy of group-based acceptance and commitment therapy program for breast cancer patients with high fear of progression

Psychooncology. 2024 Apr;33(4):e6339. doi: 10.1002/pon.6339.

Authors

Fatemeh Hassani Alimolk^{1

2}, Fiona Elizabeth Jean McDonald³, Mohammad Asghari-Jafarabadi^{4

5

6}, Farzane Ahmadi⁷, Saeedeh Zenoozian^{1

2}, Marzieh Lashkari⁸, Pandora Patterson^{9

10}

Affiliations

¹ Department of Clinical Psychology, Faculty of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran.
² Determinants of Health Research Center, Zanjan University of Medical Sciences, Zanjan, Iran.
³ Canteen, Sydney, New South Wales, Australia.
⁴ Biostatistics Unit, School of Public Health and Preventative Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia.
⁵ Cabrini Research, Cabrini Health, Malvern, Victoria, Australia.
⁶ Department of Psychiatry, School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia.
⁷ Department of Biostatistics and Epidemiology, Faculty of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran.
⁸ Department of Radiation Oncology, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
⁹ Translational Health Research Institute, Western Sydney University, Campbelltown, New South Wales, Australia.
¹⁰ Community First Step, Fairfield, New South Wales, Australia.

PMID: 38653573
DOI: 10.1002/pon.6339

Abstract

Background: Fear of progression (FOP) is a common and significant concern among cancer patients, encompassing worries about cancer progression during active treatment. Elevated levels of FOP can be dysfunctional. This study aims to assess the efficacy of an Acceptance and Commitment Therapy (ACT)-based intervention on FOP, anxiety sensitivity (AS), and quality of life (QOL) in breast cancer patients.

Methods: A clinical trial was conducted involving 80 stage I-III active-treatment breast cancer patients with a score greater than 34 on the Fear of Progression Questionnaire-Short Form scale. These patients were randomly assigned in a 1:1 ratio to either an intervention group, which received weekly 70-min sessions of 5-ACT-bsed group-therapy, or a control group that received usual treatment. Variables including FOP, AS, QOL, and ACT-related factors were assessed using ASQ, QLQ-C30, Cognitive Fusion Questionnaire, and Acceptance and Action Questionnaire-II at three time points: baseline, post-intervention, and 3-month follow-up. The efficacy of the intervention was evaluated using mixed model analysis across all time-points.

Results: The fidelity and acceptability of the ACT-based manual were confirmed using significant methods. A significant reduction in FOP was observed only in the ACT group at post-intervention (P-value_ACT < 0.001; Cohen d_ACT = 1.099). Furthermore, the ACT group demonstrated a more significant reduction in FOP at follow-up. Furthermore, all secondary and ACT-related variables, except for the physical symptoms subscale, showed significant improvement in the ACT group compared to the control group.

Conclusions: Our ACT-based manual showed promise for reducing FOP, AS, and improving QOL, and ACT-related variables in breast cancer patients 3 months following the intervention.

Keywords: acceptance and commitment therapy; breast cancer patients; fear of progression; psychological inflexibility; psychological intervention; psycho‐oncology; quality of life; sensitivity anxiety.

Publication types

Randomized Controlled Trial
Research Support, Non-U.S. Gov't

MeSH terms

Acceptance and Commitment Therapy* / methods
Adult
Aged
Anxiety* / psychology
Anxiety* / therapy
Breast Neoplasms* / psychology
Breast Neoplasms* / therapy
Disease Progression*
Fear* / psychology
Female
Humans
Middle Aged
Psychotherapy, Group* / methods
Quality of Life* / psychology
Surveys and Questionnaires
Treatment Outcome